中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (10): 1597-1603.doi: 10.12307/2022.209

• 生物材料综述 biomaterial review • 上一篇    下一篇

椎间植入材料在腰椎融合治疗中应用的优势及不足

陈政宇1，2，童  洁3，李学林1，2，晏怡果1，2   

  1. 南华大学附属第一医院，1脊柱外科，2骨科研究中心，3康复医学科，湖南省衡阳市   421001
  • 收稿日期:2021-05-06 修回日期:2021-05-11 接受日期:2021-06-01 出版日期:2022-04-08 发布日期:2021-10-27
  • 通讯作者: 晏怡果，博士，主任医师，南华大学附属第一医院脊柱外科，骨科研究中心，湖南省衡阳市 421001 李学林，副主任医师，南华大学附属第一医院脊柱外科，骨科研究中心，湖南省衡阳市 421001
  • 作者简介:陈政宇，男，1990年生，湖南省人，汉族，南华大学附属第一医院在读硕士，医师，主要从事脊柱外科方面的研究
  • 基金资助:
    湖南省自然科学基金/面上项目(2020JJ4549)，项目负责人：晏怡果；衡阳市骨科内植物研发重点实验室项目(2018KJ115)，项目负责人：晏怡果；湖南省自然科学基金/省市联合基金项目(2019JJ60032)，项目负责人：李学林

Advantages and disadvantages of interbody implant materials in lumbar fusion

Chen Zhengyu1, 2, Tong Jie3, Li Xuelin1, 2, Yan Yiguo1, 2   

  1. 1Department of Spine Surgery, 2Orthopedic Research Center, 3Department of Rehabilitation Medicine, First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
  • Received:2021-05-06 Revised:2021-05-11 Accepted:2021-06-01 Online:2022-04-08 Published:2021-10-27
  • Contact: Yan Yiguo, MD, Chief physician, Department of Spine Surgery, and Orthopedic Research Center, First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
  • About author:Chen Zhengyu, Master candidate, physician, Department of Spine Surgery, and Orthopaedic Research Center, First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
  • Supported by:
    Hunan Natural Science Foundation, No. 2020JJ4549 (to YYG); Key Laboratory Project of Research and Development of Orthopaedic Plants in Hengyang, No. 2018KJ115 (to YYG); Hunan Natural Science Foundation/Provincial and Municipal Joint Fund Project, No. 2019JJ60032 (to LXL)

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摘要： 文题释义：
理想的椎间植入材料：在无细胞毒性和良好生物相容性的前提下，具备与骨组织相近的弹性模量及刚度，且耐磨性和抗疲劳性能好，具有良好的骨诱导性和成骨、骨爬行替代的能力，利于新生骨组织长入，最终实现生物力学稳定等特点。
椎间融合术：将相邻的两个椎体通过植入椎间融合材料或辅以内固定方法变为一个整体，经融合后的椎体，由原来两个功能单位变成一个整体功能单位，称为椎间融合术。

背景：近年来随着各种新型椎间植入材料的问世与改良，有效促进了椎间融合术的发展，椎间植入材料的革新也为提高融合率夯实了重要基础。
目的：阐述目前常用的各类椎间植入材料的发展历程和优缺点，为临床上选择合适椎间融合材料提供一定参考。
方法：检索1990年1月至2021年4月间，在PubMed、中国知网、万方和中国生物医学文献数据库发表的相关中英文文献；英文检索词：“Interbody fusion materials，Autogenous bone，Allogeneic bone，Hydroxyapatite，Titanium alloy，Tantalum，Polymer，Carbon fiber，PEEK，BMP2，Lumbar fusion，Lumbar interbody fusion”；中文检索词：“椎间融合材料、融合器、自体骨、羟基磷灰石、3D打印钛合金、钽金属、聚醚醚酮、骨形态发生蛋白2、腰椎间融合术”，经筛选后最终纳入66篇文献进行综述。

结果与结论：①目前临床上应用的椎间融合材料种类繁多，具体可分为：自体骨、异体骨、羟基磷灰石、钛合金/钽金属类、高分子聚合物和骨诱导复合型材料等，且每一种材料均有着各自特性、优势及适用范围。②从客观方面来说，自体骨移植仍是临床腰椎间融合术的首选方式，但因其最大的不足是取骨量有限及供骨区相关并发症等问题，使得临床应用受到一定限制，但同时也间接促进了其他椎间植入材料的不断发展。③从椎间融合的发展历程来看，现如今更多的研究者进一步追求脊柱仿生性的融合，以期望到达生理性解剖和功能的重建。④随着材料学、组织工程学、生物力学和增材制造技术的不断深入发展，复合型椎间植入材料或含诱导因子共同组成的生物复合骨替代内植物，通过复合的形式进行了优势互补，进一步提高了椎间融合率，在脊柱融合方面具有良好的发展前景，但仍需要更长的研究周期和更大的临床样本量来探究证明真实的临床疗效。

https://orcid.org/0000-0002-2508-957X (陈政宇) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 椎间融合, 假体和植入物, 融合器, 医用材料, 骨替代品, 3D打印, 综述文献

Abstract: BACKGROUND: In recent years, with the optimization and improvement of various new interbody implant materials, it has effectively promoted the development of interbody fusion, and the renewal of interbody implant materials provides an important basis for the improvement of interbody fusion.
OBJECTIVE: To describe the development, advantages and disadvantages of all kinds of interbody implant materials commonly used at present, so as to provide some references for the selection of suitable interbody fusion materials in clinic.
METHODS: Relevant articles in Chinese and English published in PubMed, CNKI, Wanfang and China Biomedical Literature Database from January 1990 to April 2021 were retrieved. Search terms were “Interbody fusion materials, Autogenous bone, Allogeneic bone, Hydroxyapatite, Titanium alloy, Tantalum, Polymer, Carbon fiber, PEEK, BMP2, Lumbar fusion, Lumbar interbody fusion” in English and Chinese, separately. After screening, 66 articles were included and reviewed. 
RESULTS AND CONCLUSION: (1) At present, there are many kinds of interbody fusion materials used in clinic, which can be divided into autogenous bone, allogeneic bone, hydroxyapatite, titanium alloy/tantalum, polymer, and bone-induced composite materials. Each material has its own characteristics ,advantage, and scope of application. (2) From an objective point of view, autogenous bone transplantation is still the first choice for clinical lumbar interbody fusion, but its biggest deficiency is the limited bone collection and related complications in the bone donor area, which limits its clinical application. However, it also indirectly  promotes the sustained development of other intervertebral implant materials. (3) From the perspective of the development of interbody fusion, now more and more researchers further pursue the biomimetic fusion of the spine in order to achieve the reconstruction of physiological anatomy and function. (4) Nowadays, with the in-depth development of material science, tissue engineering, biomechanics and augmentation manufacturing technology, composite intervertebral implant materials or biological composite bone composed of inducing factors are used to replace internal implants. The advantages complement each other in the form of composite, which further improves the rate of interbody fusion and has a good development prospect in the field of spinal fusion. However, long research cycles and large clinical sample size are still needed to explore and prove the real clinical efficacy.

Key words: interbody fusion, prostheses and implants, cage, medical material, bone substitutes, 3D printing, review

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